Provider Demographics
NPI:1285258400
Name:KEETON, DEONZA IRENE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DEONZA
Middle Name:IRENE
Last Name:KEETON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CARLA CT
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-9000
Mailing Address - Country:US
Mailing Address - Phone:859-428-0202
Mailing Address - Fax:
Practice Address - Street 1:400 FARRELL DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-3785
Practice Address - Country:US
Practice Address - Phone:859-341-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY133204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist